• Utilization Review & Compliance Specialist

    Requisition ID
    2018-2934
    Job Locations
    OR-Portland
    Program
    Administrative/Corporate
    Relocation Assistance
    No
    Position Type
    Full-Time/Regular
  • Overview

    Who is Youth Villages?
    Youth Villages is a nonprofit organization striving to help troubled youth and families live successfully. We are a team of 2,900 individuals who’ve come together across 12 states to change the landscape of child welfare and juvenile justice across the country. Our work involves providing an array of counseling and treatment services to youth with severe emotional and behavioral problems.


    Eighty-four percent of those who go through treatment are succeeding two years after leaving our program. These youth are living at home, remaining in school, and are not experiencing trouble with the law.

    Responsibilities

    The Utilization Review & Compliance Specialist supports these two critical functions in collaboration with other key staff. Needs in each area fluctuate over the course of a given month, but approximately half of the time will be spent in each of the respective areas outlined in more detail below.

     

    Utilization Review duties
    Works closely with Placement Manager to:
    • Initiates all admission, continued stay, discharge, and other reviews according to established guidelines
    • Completes pre-certification with external review agency and communicates that results in daily intake meetings.
    • Communicates with external review agencies by telephone, mail of facsimile as required by agency.
    • Assists in facilitating transfers to other agencies by providing information necessary for precertification
    • Monitor/track funding problems
    • Summarizes trends and reports information
    • Maintains thorough and complete records of all external review agency communications.
    • Ensures confidentially of all communications with external review agency
    • Conducts concurrent reviews with external review agency and communicates results in daily intake meetings and to appropriate program staff. If appropriate, appeals any denials for continued stay

     

    Compliance duties
    Work closely with the Compliance Specialist to:
    • Support the licensing, accreditation and certifications processes with program and administrative staff.
    • Support the policy review and implementation process with the responsible parties in the programs and administration areas.
    • Coordinate Policies and Procedures that comply with current requirements.
    • Conduct ongoing regulatory standards review and make recommendations to ensure compliance with standards; assists program staff with the identification of deficiencies and interventions to overcome the areas of concern.
    • Audit organization practices to ensure compliance with applicable local, state, and federal contract, licensing, and accreditation regulations.
    • Support ongoing program audits
    • Coordinate external reporting to MHOs or other state and local contract entities.
    • Monitors high risk areas as assigned by supervisor.
    • Support agency programs to ensure guidelines and standards are met (i.e. JCAHO, OAR, CMS).
    • Conduct review of client files to assess and ensure compliance with internal policy and procedures; agency quality improvement plan and external contracts and program requirements are met.
    • Support contract review process in Oregon and file executed contracts in Sharepoint site; maintain hard files of all payor and vendor contracts.

    Qualifications

    Requirements

    Bachelor's degree is required

    A minimum of one year of experience in utilization review or compliance is required

     


    Experience growth and development through our continuous training, as well as tuition and licensure reimbursement, or pursue opportunities to advance both clinically and administratively with Youth Villages.

     

    Additional Benefits
    Medical, Dental, Prescription Drug Coverage and Vision
    Retirement Savings Pension Plan
    403 (b)
    2 weeks paid vacation
    12 paid sick days per year
    10 paid holidays
    Paid Paternal Leave
    Mileage & Cell Phone Reimbursement (when applicable)


    EOE

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